Report (25) insT oil — 00308
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FIRE SAFETY SYSTEMS
AQUASAFETM FLOW TEST
VERIFICATION
AquaSAFE' Flow Test Verification Form
Alliance
Important Installing contractor must submit this
Member ID: _ completed form.Failure to do so nullifies the
Company Name: _.� !di,�+rnc�' P'u`rer system warranty.Email or fax completed form
to the Uponor Fire Safety Design Department
Contact: 1-f I):s.1-0Yvtin at technicalservices@u
ponor.com or 952.997.7731.
Phone"_ 503-y —*F1 d For questions,contact Uponor Technical Services at
888.594.7726 or technical.services@uponor,com.
Fax: n'
Color of test orifice used: /�l we
Job Name: " ( �t( Tal-ok
�� �� Static pressure(not flowing)reading at incoming
Project Number: water supply into home or at main shutoff: 93
Job Address: (gO(:)) Stay j IAS
- Residual pressure(flowing)reading at incoming water
City. I ei.de +Ci
supply into home or at main shutoff: (9t`)
State,ZIP: Ota C7)007)
For designs not provided by Uponor, complete the What time of day was the flow test taken? /
following information. Flow test method used? Bucket J Flow Meter
Designer's Name: _ gi,e KU 1 k,( Flow test gpm: 't a
Company: "1ppn How many gallons o water did the design predict
5 -� �q� as required?
Phone: (3
Did the test meet or exceed design flow? Ar Yes ]No
Fax:
Which sprinkler did you flow?Number: fi
Is the warning sign permanently attached close to the
main shutoff valve? ]Yes ,N No Location of head: ( c
On #-3ni5 Yes No i jie
Was this system required by code?(AP i Date left in service with all valves open: 9 1
Test Witnessed and Verified by:
Name Signature
Name
�, � N. Occypation Dat
a,
Additional Explanations and Notes
LLI
Uponor,Inc. Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
LLApple Valley,MN 55124 USA Web:www.uponor-usa.com